Australia

A parliamentary committee has recommended that the Australian state of Queensland should legalise voluntary assisted dying for adults with an advanced terminal illness.

Currently over one-third of Australians have, (or shortly will have), access to a form of assisted dying since the state of Victoria passed its voluntary assisted dying law in 2017, followed by Western Australia in 2019. If Queensland follows, this would give the option of an assisted death to well over half (57%) of Australians.

 The Queensland report recommends that any assisted dying legislation there should be limited to:

• Adults over 18
• Queensland residents
• Those ‘having an advanced and progressive terminal, chronic or neurodegenerative medical condition that cannot be alleviated in a manner acceptable to the person, and that the condition will cause death.’
• People with ‘decision-making capacity’.

Any conversation about the possibility of an assisted death would have to be instigated by the person wishing to die. Counselling should be available to anyone who requests it, but should not be compulsory, as some submissions to the enquiry had advocated.

Importantly the report recommends that the legislation should not be limited to a ‘precise timeframe for a person’s anticipated date of death … due to the complex, subjective and unpredictable nature of the prognosis of terminal illness.’ This follows from the Canadian model, which was cited in evidence to the enquiry.  

Another thoughtful recommendation is that ‘the coordinating practitioner may determine whether self-administration of the substance or administration by the practitioner is the method best suited to the patient.’ It would permit the lethal substance to be provided intravenously, controlled either by the patient or by the doctor. This overcomes one of the problems with oral methods used in Oregon and other US states. Experience from the organisation Lifecircle in Switzerland, indicates that the Intravenous method is the quickest and most reliable, as their IV method (in which the client opens the cannula) results in a person falling asleep within thirty seconds and dying peacefully within four minutes. This recommendation again follows the example of Canada.

Mental illness is a question that often comes up in assisted dying debates. The report recommends that provided the person has the mental capacity to make a life-ending decision, any mental illness itself should not prevent an otherwise valid request for an assisted death.

Despite the careful analysis demonstrated in the report, an Australian newspaper, The Age, points out that political focus in Queensland is rightly concentrated on tackling the Covid-19 crisis. It is currently unclear when legislation will be proposed.

Phil Cheatle the Lead Campaign Commentator for My Death, My Decision said:

‘The Queensland report is encouraging as it pays close attention to important nuances of the assisted dying debate and takes on board experience from Victoria and Canada. It recommends following Canada in not limiting assisted dying to a strict prognosis time limit such as 6 months and in permitting intravenous delivery. These overcome two serious criticisms of the US/Oregon approach and we strongly endorse Queensland’s decision to avoid them.’

Excellent news from Australia. Further to our previous report, the upper house of the Australian state of Victoria has passed a Voluntary Assisted Dying bill. The bill passed by 22 to 18 after a 28 hour sitting. The progress is reported in this Guardian article.

The debate in the upper house caused some amendments to the original bill, in particular, one which tightened the life-expectancy requirement from 12 months to 6 months unless the patient is suffering a neurodegenerative illness such as motor neuron disease. Although this is more restrictive than MDMD would like to see, as it is unlikely to be applicable to early stage dementia patients who would wish to end their lives while they still have the mental capacity to do so, this is a welcome step forward beyond the rigid six-month life expectancy criterion used by states such as Oregon in USA, and proposed for the UK in September 2015. The changes to the Victoria bill still need to be ratified by the lower house, but this is reported to be a formality which will be completed next week.

The Guardian article cautions “The law comes into operation in June 2019. … The next state election is due in November next year and already opponents are saying they will campaign to have the law repealed before it ever commences.” Although the battle is not yet over, very significant progress has been made.

Looking at how and why such progress came about in Victoria, the Guardian article identifies the following factors in its interviews with those involved in the debate there:

• The process was sponsored by the Victoria government, rather than it being a private members’ bill. This gave it significant additional resources and authority.
• The Victoria Premier Daniel Andrews, supported the Bill. Andrews, a Catholic, changed his mind on assisted dying after his father died of cancer last year.
• There was a properly informed debate. The facts were used to overcome the unfounded fears and uncertainties spread by those opposed to the bill.

How long will we, in the UK, have to wait until we have a government in tune with the electorate on this issue? Perhaps when we have a prime minister who has witnessed at first hand the demise of a close relative with dementia, when the person’s rational requests for a medically assisted death are refused, or when the person takes their own life in desperation, like Sir Nicholas Wall did earlier this year. Dementia is now the leading cause of death in England and Wales. Many more die with it rather than of it. Dementia sufferers who seek a medically assisted death can obtain one, provided they act while they still have the mental capacity to make a life ending decision. However, they can only do this by going through the arduous process of arranging it in Switzerland. A recent report shows how difficult this process is.